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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197608998
Report Date:
09/02/2022
Date Signed:
09/02/2022 12:16:38 PM
Document Has Been Signed on
09/02/2022 12:16 PM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
CANYON TRAILS AT TOPANGA SENIOR LIVING
FACILITY NUMBER:
197608998
ADMINISTRATOR:
SUSAN WEISBARTH
FACILITY TYPE:
740
ADDRESS:
7945 TOPANGA CANYON BLVD
TELEPHONE:
(818) 716-9900
CITY:
CANOGA PARK
STATE:
CA
ZIP CODE:
91304
CAPACITY:
120
CENSUS:
91
DATE:
09/02/2022
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
09:30 AM
MET WITH:
Susan Weisbarth
TIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced case management visit due to a self reported incident sent in by the facility on 8/31/22. LPA met with the administrator and explained the reason for this visit.
Incident report was received regarding resident # 1(R1) being seen on 8/24/22 and 8/25/22 by LVN and home health aid. On 8/26/22 administrator received a phone call reporting skin changes for R1. R1 was then assessed by facility staff and no skin changes were noted. On 8/30/22 Law Enforcement came to the facility to investigate a report of suspected elder abuse regarding R1. R1 was interviewed and observed by Law enforcement and a report was made to Adult Protective Services(APS) by with a conclusion of no suspected abuse. LPA reviewed outside agency documentation of the visits made by the LVN and home health on 8/24/22 and 8/25/22. On the notes it was noted by both that there were no changes and skin was intact. It also stated that R1 was being well taken care of. LPA also obtained copy of communication from Law Enforcement regarding their visit and that no suspected abuse was found. LPA also received pictures of R1. LPA was not able to interview R1 due to R1's medical diagnosis. Facility still decided to have an in-service with staff regarding being a mandated reporter and reporting changes in condition. LPA recieved a copy of the sign in sheet Based on the information obtained through interviews and documentation no further action is necessary.
Exit interview conducted.
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
09/02/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
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